Fiscal Year 2010 Appropriations Request Form Congressman Joe Crowley (NY-7) Instructions: Please send a brief cover letter with a summary of the project request and the form below filled out to our office by February 26, 2009 Mail: Congressman Joseph Crowley 2404 Rayburn HOB Washington, DC 20515 Attn: Kevin Casey Email: Kevin.casey@mail.house.gov Nicole Cohen Email: Nicole.cohen@mail.house.gov Project Details Name of groups seeking funds: Name of project to be funded: Description of project seeking funding (100 words or less): Location within Congressman Joe Crowley's Congressional District where these funds will be used. (Please note - Only requests that benefit the 7th Congressional District will be considered. Responses such as "Queens, the Bronx, or New York City" - do NOT count as an adequate response and will not be considered for funding.) Name, Address, Telephone, Fax, and Email of Organization seeking Funding: Name, Address, Email, Work, Home AND Mobile Numbers for Organization Contact: Amount Requested (in $): Has this Project been funded previously by Congressman Crowley; if so, how much and when? Has this Project been funded previously by the Federal government, if so, how much and when? Has this program received any State, City or Borough funding? If so, how much, and when? Have other Congressional/Senate Offices been or will be contacted? (Yes/No): Attach additional congressional contacts as an addendum. Name of Office Staffer Name Telephone # Email Address Have you ever sought a Federal grant to fund this project previously? Funding / Account Details (if known) Name of budgetary account/subaccount and Federal agency requesting to be funded under: Agency Account Subaccount Does this project require a non-Federal matching fund? (if known) Please detail any other sources of funding - including private sources. Include points of contact (names/phone #'s/email) of any other funding sources.